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News » $7Bn Medicare fraud uncovered in South Florida call centers

$7Bn Medicare fraud uncovered in South Florida call centers

Medicare fraud in call centers

FLORIDA, UNITED STATES — U.S. Federal agents have exposed a network of call centers in South Florida orchestrating a Medicare fraud operation worth approximately $7 billion. 

The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) provided evidence of calls deceiving elderly individuals into agreeing to unnecessary genetic tests. 

In a notable instance, an 84-year-old man identified a fraudulent attempt to persuade him to undergo heart disease genetic testing.

Stephen Mahmood, an Assistant Special Agent in Charge at the Miami office of HHS-OIG, detailed these fraudulent activities that originated from an unnamed call center in Boca Raton, a city in Palm Beach County, Florida.

He explained that the fraud involves tricking Medicare recipients into accepting unneeded genetic tests for various conditions, with complicit doctors and labs facilitating the billing to Medicare.

“We have arrested people. But, you know, the fraud hasn’t stopped. We have limited resources. We do the best we can,” Mahmood added. 

Multiple individuals faced charges linked to the Boca Raton call center’s fraudulent activities. Among them are brothers Daniel and Louis Carver, who admitted guilt for filing fraudulent claims exceeding $67 million for unnecessary genetic tests and medical equipment. 

Additionally, Jose Goyos was found guilty of deceiving doctors into approving these illegitimate orders.

Mahmood highlighted that South Florida has become a hotspot for such fraudulent operations, with many operating covertly. 

The scam begins with the misuse of Medicare recipient information, leading to targeted calls. In return for prescribing these unwarranted tests, doctors and medical providers receive kickbacks, and fraudulent claims are submitted for Medicare reimbursement.

The cost of these genetic testing scams to taxpayers has reached over $7 billion. Mahmood acknowledged the challenges in combating these schemes due to resource constraints.

However, he also emphasized that the battle against healthcare fraud in the region is far from over, with new schemes continually emerging.

The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program, said that they are committed to preventing fraud and protecting people from falling victim to fraud.

“CMS does not confirm or discuss the existence of any ongoing investigation to ensure we do not compromise the integrity of the investigative process. However, that does not mean actions are not taken behind the scenes,” a CMS spokesperson stated.

Read more here.

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